Effectiveness of using reward strategies combined with transcranial direct current stimulation(RstDCS) on motivation in chronic stroke patients with upper limb disorders：study protocol for a randomized controlled trial

IntroductionStroke survivors tend to have low motivation for rehabilitation, which prevent them from completing the rehabilitation training task effectively and participating in daily activities. Reward strategies can stimulate patients motivation for rehabilitation, but the duration of their effect is unknown. tDCS is a technique capable of promoting plastic changes and functional reorganization of cortical functional areas. When it acts on dlPFC, it can improve the functional connectivity of brain areas associated with goal-directed behavior. Reward strategies combined with tDCS (RstDCS) have been shown to make normal individuals work harder at performing tasks. However, there are no studies on whether this combined strategy improves motivation in stroke patients and whether it has a long-lasting effect on motivation maintenance. Methods and analysis87 stroke survivors who have low motivation and upper extremity dysfunction will be randomized to receive conventional, Rs, or RstDCS treatment. Patients in each group will undertake 15 sessions of tDCS real or sham stimulation of the left dlPFC for 3 weeks in conjunction with conventional rehabilitation or reward strategy training. Following this, the RS treatment group and RstDCS treatment group will be given a 3-week outpatient self-monitoring training program, while the conventional group will be given home rehabilitation instruction prior to discharge. Rehabilitation motivation is the primary outcome measure and will be assessed using RMS. RMS,FMA, FIM and ICF activity and social engagement scale will be compared at baseline, 3 weeks, 6 weeks, and 3 months after enrollment. Ethics and disseminationThe study has been approved by the Ethics Committee of Yueyang Hospital of Integrated Chinese and Western Medicine Affiliated to SHUTCM (2021-122). All participating patients will provide written informed consent. The results will be disseminated through (open access) peer-reviewed publications, networks of scientists, professionals, and the public. Trial registration number: ChiCTR2300069068